LAHORE: Murad, 39, was dragged in for proper medical care after `alternative healing` failed to cure him. A `pir` or spiritual leader had shaved Murad`s head and made several small cuts all over his scalp for his `impure blood` to seep out and cleanse him. His family was tired of Murad`s aggressive behavior but after the `pir` failed, Murad was taken to a hospital, where the psychiatrist finally diagnosed him to be suffering from manic depression.

`This is nothing,` says senior psychiatrist Dr Nisar Baluch, `There are patients who are tortured in the name of treatment. Some are tied up in ropes or chains for days without food or water. Some are hung upside down.

And contrary to what people may think, this is a far more common practice with mental patients than proper treatment.

Diagnosing mental illness is a huge issue in Pakistan for many reasons.

While `pirs` and quacks continue to fool the patients and their family into believing the problem is supernatural rather than medical, there is another side to the picture too. Costs of treatment are too high, equipment is not available, there is a lack of trained staff and above all, not many doctors are in the field.

But the biggest problem is that although there has been no formal survey to determine the exact statistics(the last census to be in 1998 is still pending), the number of mental patientsinPakistanishigh.Depression and anxiety for instance is said to affect at least 60pc of the population, and continues to rise. And despite the high number of patients suf fering from mental illness, it receives hardly any focus in the GDP budget. The allocation of resources for mental health is only 2.4pc, which translates into $20 per person.

In fact, the WHO has recommended that at least six percent of the GDP be allocated to this cause. Total public health spending is already less than 1pc of the GDP, itself a figure that should be cause for serious concern, but mental health does not have a separate budget.

Even within the health budget, the attention is primarily given to infectious diseases and child and maternal issues, while mental health`s impact on society and economy is rarely recognised.

`While mental health gets almost nothing in the budget, even within its paradigms you can see that most of it goes to young to middle-aged people, not to the elderly or children,` says Dr Nazish, assistant professor of child psychiatry at the King Edward Medical University (KEMU).

`Elderly often face issues such as dementia and even Alzheimers, while most of ment al health problems emerge in early teens.

To add to the problem, there are only about 350 to 400 mental health psychiatrists for every 500,000 people, whilethe recommended ratio should be 1:10,000. But Dr Nisar Baluch says this figure is generous.

`I would estimate the figure to be even lower, around 270 doctors nationwide, because many of them have moved abroad and work there,` he says.

And because of such few doctors, it is difficult to imagine any kind of community work.

Dr Nazish says psychiatrists in the world have begun community worl( including schools, but it is a prospect which seems impossible here because of the lack of system, and because of very few doctors who can collaborate.

Moreover, mental health experts are centered in mid to large sized cities (urban areas) while there are next to none at district level. At least 68pc of the population lives in rural areas and small districts but there is no awareness nor access to mental health facilities.

And thanks to such low resource allocation, there are obviously few hospitals providing proper mental health care and those that are operating, face a dearth of proper medical equipment, and trained staff. For instance Mayo Hospital alone deals with around 40,000 patients in one year.

Dr Sameeha Aleem, who works for a one-of-its-kind `tele-psychyiatry` unit, which provides online help to train staff in the Dadar district of KP, says some patients have an organic problem which requires brain imaging.